Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women : a short version Cochrane systematic review with meta-analysis

Background Pelvic floor muscle training (PFMT) is a commonly used physical therapy for women with urinary incontinence (UI). Objectives To determine the effects of PFMT for women with UI in comparison to no treatment, placebo or other inactive control treatments. Search Methods Cochrane Incontinence Group Specialized Register, (searched 15 April 2013). Selection Criteria Randomized or quasi-randomized trials in women with stress, urgency or mixed UI (based on symptoms, signs, or urodynamics). Data Collection and Analysis At least two independent review authors carried out trial screening, selection, risk of bias assessment and data abstraction. Trials were subgrouped by UI diagnosis. The quality of evidence was assessed by adopting the (GRADE) approach. Results Twenty-one trials (1281 women) were included; 18 trials (1051 women) contributed data to the meta-analysis. In women with stress UI, there was high quality evidence that PFMT is associated with cure (RR 8.38; 95% CI 3.68 to 19.07) and moderate quality evidence of cure or improvement (RR 17.33; 95% CI 4.31 to 69.64). In women with any type of UI, there was also moderate quality evidence that PFMT is associated with cure (RR 5.5; 95% CI 2.87–10.52), or cure and improvement (RR 2.39; 95% CI 1.64–3.47). Conclusions The addition of seven new trials did not change the essential findings of the earlier version of this review. In this iteration, using the GRADE quality criteria strengthened the recommendations for PFMT and a wider range of secondary outcomes (also generally in favor of PFMT) were reported.

Pelvic-floor-muscle-training adherence “modifiers” : a review of primary qualitative studies : 2011 ICS State-of-the-Science Seminar research paper III of IV

Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing “modifiers” of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six “modifiers” of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the “modifiers” of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.

Health professionals’ and patients’ perspectives on pelvic floor muscle training adherence : 2011 ICS State-of-the-Science Seminar research paper IV of IV

Aims There is scant information on pelvic floor muscle training (PFMT) adherence barriers and facilitators. A web-based survey was conducted (1) to investigate whether responses from health professionals and the public broadly reflected findings in the literature, (2) if responses differed between the two groups, and (3) to identify new research directions. Methods Health professional and public surveys were posted on the ICS website. PFMT adherence barriers and facilitators were divided into four categories: physical/condition, patient, therapy, and social-economic. Responses were analyzed using descriptive statistics from quantitative data and thematic data analysis for qualitative data. Results Five hundred and fifteen health professionals and 51 public respondents participated. Both cohorts felt “patient-related factors” constituted the most important adherence barrier, but differed in their rankings of short- and long-term barriers. Health professionals rated “patient-related” and the public “therapy-related” factors as the most important adherence facilitator. Both ranked “perception of PFMT benefit” as the most important long-term facilitator. Contrary to published findings, symptom severity was not ranked highly. Neither cohort felt the barriers nor facilitators differed according to PFM condition (urinary/faecal incontinence, pelvic organ prolapse, pelvic pain); however, a large number of health professionals felt differences existed across age, gender, and ethnicity. Half of respondents in both cohorts felt research barriers and facilitators differed from those in clinical practice. Conclusions An emphasis on “patient-related” factors, ahead of “condition-specific” and “therapy-related,” affecting PFMT adherence barriers was evident. Health professionals need to be aware of the importance of long-term patient perception of PFMT benefits and consider enabling strategies.

How are Canadian universities training and supporting undergraduate medical, physiotherapy and occupational students for global health experiences in international low-resource settings?

Abstract : OBJECTIVES : Canadian medical (MD), physiotherapy (PT) and occupational therapy (OT) students increasingly show an interest in global health experiences (GHEs). As certain moral hazards can occur as a result of student GHEs, a growing consensus exists that universities must have an established selection process, in-depth pre-departure training (PDT), adequate onsite supervision and formal debriefing for their students. This study aimed at identifying current practices in Canadian MD, PT and OT programs and discussing areas for improvement by comparing them with recommendations found in the literature. METHODS : Canadian MD, PT and OT programs (n = 45) were invited to answer an online survey about their current practices for GHE support and training. The survey included 24 close-ended questions and 18 open-ended questions. Descriptive statistics and a thematic analysis were performed on the data and results were discussed with recommendations found in the literature. RESULTS : Twenty-three programs responded to the survey. Student selection processes varied across universities; examples included using academic performance, interviews and motivation letters. All but 1 MD program had mandatory PDT; content and teaching formats varied, as did training duration (2-38 hours). All but 1 MD program had onsite supervision; local clinicians were frequently involved. Debriefing, although not systematic, covered similar content; debriefing was variable in duration (1-8 hours). CONCLUSIONS : Many current practices are encouraging but areas for improvement exist. Integrating global health content into the regular curriculum with advanced study option in global health for students participating in GHEs could help universities standardize support and training.

Assessments of training load in elite youth soccer

One of the most popular sports globally, soccer has seen a rise in the demands of the game over recent years. An increase in intensity and playing demands, coupled with growing social and economic pressures on soccer players means that optimal preparation is of paramount importance. Recent research has found the modern game, depending on positional role, to consist of approximately 60% more sprint distance in the English Premier League, which was also found to be the case for frequency and success of discrete technical actions (Bush et al., 2015). As a result, the focus on soccer training and player preparedness is becoming more prevalent in scientific research. By designing the appropriate training load, and thus periodization strategies, the aim is to achieve peak fitness in the most efficient way, whilst minimising the risk of injury and illness. Traditionally, training intensity has been based on heart rate responses, however, the emergence of tracking microtechnology such as global positioning system (GPS) and inertial sensors are now able to further quantify biomechanical load as well as physiological stress. Detailed pictures of internal and external loading indices such as these then combine to produce a more holistic view of training load experience by the player during typical drills and phases of training in soccer. The premise of this research is to gain greater understanding of the physical demands of common training methodologies in elite soccer to support optimal match performance. The coaching process may then benefit from being able to prescribe the most effective training to support these. The first experimental chapter in this thesis began by quantify gross training loads of the pre-season and in-season phases in soccer. A broader picture of the training loads inherent in these distinct phases brought more detail as to the type and extent of external loading experienced by soccer players at these times, and how the inclusion of match play influences weekly training rhythms. Training volume (total distance) was found to be high at the start compared to the end of pre-season (37 kilometres and 28 kilometres), where high cardiovascular loads were attained as part of the conditioning focus. This progressed transiently, however, to involve higher-speed, acceleration and change-of-direction stimuli at the end of pre-season compared to the start and to that in-season (1.18 kilometres, 0.70 kilometres and 0.42 kilometres high-intensity running; with 37, 25 and 23 accelerations >3m/s2 respectively) . The decrease in volume and increase in maximal anaerobic activity was evident in the training focus as friendly matches were introduced before the competitive season. The influence of match-play as being a large physical dose in the training week may then determine the change in weekly periodisation and how resulting training loads applied and tapered, if necessary. The focus of research was then directed more specifically to the most common mode of training in soccer, that also featured regularly in the pre-season period in the present study, small-sided games (SSG). The subsequent studies examined numerous manipulations of this specific form of soccer conditioning, such as player numbers as well as absolute and relative playing space available. In contrast to some previous literature, changing the number of players did not seem to influence training responses significantly, although playing format in the possession style brought about larger effects for heart rate (89.9%HRmax) and average velocity (7.6km/h-1). However, the following studies (Chapters 5, 6 and 7) revealed a greater influence of relative playing space available to players in SSG. The larger area at their disposal brought about greater aerobic responses (~90%HRmax), by allowing higher average and peak velocities (>25km/h-1), as well as greater distance acceleration behaviour at greater thresholds (>2.8m/s2). Furthermore, the data points towards space as being a large determinant in strategy of the player in small-sided games (SSG), subsequently shaping their movement behaviour and resulting physical responses. For example, higher average velocities in a possession format (8km/h-1) reflects higher work rate and heart rate load but makes achieving significant neuromuscular accelerations at a high level difficult given higher starting velocities prior to the most intense accelerations (4.2km/h-1). By altering space available and even through intentional numerical imbalances in team numbers, it may be easier for coaches to achieve the desired stimulus for the session or individual player, whether that is for aerobic and neuromuscular conditioning. Large effects were found for heart rate being higher in the underloaded team (85-90%HRmax) compared to the team with more players (80-85%HRmax) as well as for RPE (5AU versus 7AU). This was also apparent for meterage and therefore average velocity. It would also seem neuromuscular load through high acceleration and deceleration efforts were more pronounced with less numbers (given the need to press and close down opponents, and in a larger area relative to the number of players on the underloaded team. The peak accelerations and deceleration achieved was also higher when playing with less players (3-6.2m/s2 and 3-6.1m/s2) Having detailed ways in which to reach desired physical loading responses in common small training formats, Chapter 8 compared SSG to larger 9v9 formats with full-size 11v11 friendly matches. This enabled absolute and relative comparisons to be made and to understand the extent to which smaller training formats are able to replicate the required movements to be successful in competition. In relative terms, it was revealed that relative acceleration distance and Player Load were higher in smaller 4v4 games than match-play (1.1m.min-1 and 0.3m.min-1 >3m/s2; 16.9AU versus 12AU). Although the smallest format did not replicate the high-velocity demands of matches, the results confirmed their efficacy in providing significant neuromuscular load during the training week, which may then be supplemented by high-intensity interval running in order to gain exposure to more maximal speed work. In summary, the data presented provide valuable information from GPS and inertial sensor microtechnology which may then be used to understand training better to manipulate types of load according to physical conditioning objectives. For example, a library of resources to direct planning of drills of varying cardiovascular, neuromuscular and perceptual load can be created to give more confidence in session outcomes. Combining external and internal load data of common soccer training drills, and their application across different phases and training objectives may give coaches a powerful tool to plan and periodize training.

An Evaluative Model to Assess the Organizational Efficiency in Training Corporations

In an organisation any optimization process of its issues faces increasing challenges and requires new approaches to the organizational phenomenon. Indeed, in this work it is addressed the problematic of efficiency dynamics through intangible variables that may support a different view of the corporations. It focuses on the challenges that information management and the incorporation of context brings to competitiveness. Thus, in this work it is presented the analysis and development of an intelligent decision support system in terms of a formal agenda built on a Logic Programming based methodology to problem solving, complemented with an attitude to computing grounded on Artificial Neural Networks. The proposed model is in itself fairly precise, with an overall accuracy, sensitivity and specificity with values higher than 90 %. The proposed solution is indeed unique, catering for the explicit treatment of incomplete, unknown, or even self-contradictory information, either in a quantitative or qualitative arrangement.

High body mass index is not a barrier to physical activity: Analysis of international rugby players' anthropometric data

Recent data indicate that levels of overweight and obesity are increasing at an alarming rate throughout the world. At a population level (and commonly to assess individual health risk), the prevalence of overweight and obesity is calculated using cut-offs of the Body Mass Index (BMI) derived from height and weight. Similarly, the BMI is also used to classify individuals and to provide a notional indication of potential health risk. It is likely that epidemiologic surveys that are reliant on BMI as a measure of adiposity will overestimate the number of individuals in the overweight (and slightly obese) categories. This tendency to misclassify individuals may be more pronounced in athletic populations or groups in which the proportion of more active individuals is higher. This differential is most pronounced in sports where it is advantageous to have a high BMI (but not necessarily high fatness). To illustrate this point we calculated the BMIs of international professional rugby players from the four teams involved in the semi-finals of the 2003 Rugby Union World Cup. According to the World Health Organisation (WHO) cut-offs for BMI, approximately 65% of the players were classified as overweight and approximately 25% as obese. These findings demonstrate that a high BMI is commonplace (and a potentially desirable attribute for sport performance) in professional rugby players. An unanswered question is what proportion of the wider population, classified as overweight (or obese) according to the BMI, is misclassified according to both fatness and health risk? It is evident that being overweight should not be an obstacle to a physically active lifestyle. Similarly, a reliance on BMI alone may misclassify a number of individuals who might otherwise have been automatically considered fat and/or unfit.